Optimizing the risk stratification of an unfavorable near-term prognosis in patients with a high risk of pulmonary embolism
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https://orcid.org/0000-0003-4105-1915
Abstract
The aim – to develop and validate a scale for the additional risk of early death in patients with high-risk pulmonary embolism.
Materials and methods. At the 1st stage of the study, a formula for additional stratification of the risk of early death of high-risk PE patients was developed. With the help of ROC analysis, it was established that the sensitivity of the received prognostic formula is 64.0 %; specificity 92.1 %. Based on the formula, we proposed the SBAFS scale (S – saturation, B – bifurcation, A – arterial hypotension, F – ejection fraction, S – female gender). To further verify the proposed scale and formula, the II stage of the study was conducted on a multicenter cohort (8 centers in Ukraine that provided information on high-risk PE patients who were hospitalized for the period from 01.01.2023 to 12.2023). At this stage, 75 high-risk PE patients were included, the average age was (60.60±13.40) years, among them there were 38 (50.7 %) men, 37 (49.3 %) women. The first group consisted of 65 (80 %) patients who were discharged from the hospital with improvement, and the second group – 15 (20 %) patients died during hospitalization due to an acute episode of PE. Clinical and anamnestic, laboratory and instrumental indicators were analyzed, statistical analysis was performed data.
Results and discussion. It was established that in the II subgroup of patients with high-risk PE, not only the average value of the Y indicator was significantly higher than in the I subgroup: (0.785±0.250) and (0.306±0.330), p=0.00002, but also the proportion of patients with indicator Y>0.5: 13 (86.7 %) and 16 (26.7 %), respectively, p=0.00001. In order to check the sensitivity and specificity of the formula, we performed a ROC analysis for the II stage of our research: the sensitivity of the prognostic formula we obtained is 93.3 %; specificity of 74.6 %, which confirms the result of the 1st stage. When checking the SBAFS scale recommended by us, it was also established that the average score on the scale was (2.53±0.83) in patients of the II group and was higher than in the I group: (1.57±0.96), p=0,0006.
Conclusions. The main factors associated with the risk of in-hospital death in high-risk PE patients are a decrease in oxygen saturation, thrombus localization in the LA bifurcation according to MSCT-angiography, arterial hypotension, female sex, and a decrease in the left gastric ejection fraction according to Echo-CG. The previously proposed SBAFS risk scale confirmed its value when tested with the participation of cardiologists from 8 regions of Ukraine – sensitivity 93 %, specificity – 75 %. The possibility of using a simplified assessment of the risk of early death in patients with PE with a high total score was confirmed, as this indicator was significantly higher in the deceased – 2.5 against 1.6 (р=0.0006).
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References
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